Provider Demographics
NPI:1104851930
Name:MAC NEW, WILLIAM THOMAS JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MAC NEW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:314 N BROAD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2191
Mailing Address - Country:US
Mailing Address - Phone:770-867-4146
Mailing Address - Fax:770-867-3742
Practice Address - Street 1:314 N BROAD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2191
Practice Address - Country:US
Practice Address - Phone:770-867-4146
Practice Address - Fax:770-867-3742
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA21755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000253756AMedicaid
GA000253756AMedicaid